A genetic parent is one who has provided the gametes – the mature sex cells of males and females – which are the source of the fertilised ovum (the zygote) from which the baby devel-ops: the spermatozoon comes from the man and the ovum from the woman (Tiran 2008; Martin 2010). At a minimum each child must have:
•
a genetic mother•
a genetic father.The exceptions to this rule would be reproductive cloning, currently illegal in most countries and use of mitochondrial replacement therapy (Human Reproductive Cloning Act, 2001; Wyatt, 2009; Human Fertilisation and Embryology Authority [HFEA], 2013). Traditionally, parents would have been in a social contract of marriage and the child would have been carried in the womb of his genetic mother, being the progeny of both his genetic mother and genetic father, who would also be responsible for his nurture (see Figure 5.3).
A biological parent is one with whom the child has a direct biological connection; either through their gametes, or through being carried in a woman’s uterus during pregnancy (Ber
Figure 5.3 A traditional nuclear family: husband, wife and baby.
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2000). Figures 5.4–5.9 are essentially the same Venn diagram used to illustrate different facets of the mothering role as it exists today. Each diagram emphasises a different aspect of mother-hood. A biological mother (see Figure 5.4) may, therefore, be considered to be:
•
the woman who provides the ovum for conception (genetic mother), or•
the woman who carries the pregnancy to term (gestational mother).Due to surrogacy arrangements and more traditionally, adoption and fostering arrangements gestational mothers may be subdivided into one of the following categories:
•
A genetic mother, who has conceived a child through natural means of sexual intercourse with the genetic father, or through artificial insemination by husband, male partner, or by sperm donor. In partial surrogacy (see Figure 5.6) the genetic mother also acts as the gestational mother who will relinquish the child.•
A woman who has conceived through in-vitro fertilisation, using donor gametes (oocyte or sperm, or a donor embryo), who intends to be the social mother of this child. Her biological connection to the child is through containing, maintaining and sustaining him or her through pregnancy (see Figure 5.9).•
A woman who has conceived through in-vitro fertilisation, using donor gametes (or a donor embryo), who intends to relinquish the child after birth – a gestational (full) surrogate mother (see Figure 5.9); her biological connection to the child is also through pregnancy.Those parents who fulfil the nurturing role for the child during pregnancy and beyond, or only after birth can be called the social parents (Ber 2000): social parents may have no genetic connection to the child. In a surrogacy arrangement they would be known as the commission-ing parents. A child may have at least one social parent, who may be:
Figure 5.4 Venn diagram illustrating the division of social and biological mothering in gestational surrogacy (Ber 2000; Erin & Harris 1991; FIGO Committee for the Ethical Aspects of Human
Reproduction and Women’s Health 2008).
Social mother
Traditional mother
Gestational mother Genetic
mother
Biological mother
May be applied to either the genetic or gestational mothers
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Figure 5.5 Venn diagram illustrating the social and biological roles of traditional mothers (Ber 2000; Erin & Harris 1991; FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health 2008).
Social mother
Traditional mother
Gestational mother Genetic
mother
Traditionally an adoptive mother, a stepmother, or a foster mother could also have fulfilled the social mothering role.
A traditional mother is the source of the egg, carries the pregnancy and nurtures the baby after birth, fulfilling genetic, gestational and social roles
Traditionally the relinquishing mother, who gave up her child for adoption, or foster care would fulfil the genetic and gestational mothering roles.
Figure 5.6 Venn diagram illustrating the division of social and biological mothering in traditional surrogacy (Ber 2000; Erin & Harris 1991; FIGO Committee for the Ethical Aspects of Human
Reproduction and Women’s Health 2008).
Social mother
Traditional mother
Gestational mother Genetic
mother
Traditional (partial) surrogacy Partial or traditional surrogacy is where the gestational mother is the source of the egg and carries the pregnancy, but another social mother nurtures the baby after birth. The baby is genetically related to the surrogate.
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Figure 5.7 Venn diagram illustrating the division of social and biological mothering in gestational surrogacy where the social mother is also the genetic mother (Ber 2000; Erin & Harris 1991; FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health 2008).
Social mother
Traditional mother
Gestational mother Genetic
mother
Gestational surrogacy
Gestational (full) surrogacy Social mother = genetic mother
≠ gestational mother
In gestational surrogacy the social mother may provide the egg, the gestational mother conceives through in vitro fertilization (IVF) and carries the baby to term.
The social mother, who nurtures the child is also genetically related to the baby.
Figure 5.8 Venn diagram illustrating the division of social and biological mothering in gestational surrogacy where the social mother is not the genetic mother (Ber 2000; Erin & Harris 1991; FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health 2008).
Social mother
Traditional mother
Gestational mother Genetic
mother
Gestational surrogacy
Gestational (full) surrogacy Social mother ≠ genetic mother
≠ gestational mother A further form of gestational surrogacy is where one woman is the genetic mother, or egg donor, the gestational mother carries the baby to term, and another woman, the commissioning mother, acts as the social mother. There is no genetic relationship between the baby and the social or surrogate mothers.
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Figure 5.9 Venn diagram illustrating the social and gestational mother intersection, when a woman conceives by ovum or embryo donation (Ber 2000; Erin & Harris 1991; FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health 2008).
Social mother
Traditional mother
Gestational mother Genetic
mother
Conception with donor oocyte or embryo
Non-surrogacy donor oocyte/ or embryo, develops in the womb of the gestational mother is also the social mother A final category is women who conceive using a donor embryo, who are both the gestational mother and the social mother. This is not a surrogacy arrangement.
•
a social mother (see Figure 5.5)•
a social father (see Figure 5.10).A child may also legally have two social parents of the same gender (Griffith 2010).
A social mother may be:
•
A traditional mother (see Figure. 5.5): a woman who fulfils all three roles the genetic mother, gestational mother and the social mother.•
A woman (the commissioning mother) who intends to raise a child carried by a surrogate mother (the gestational mother). She may also be the genetic mother, whose ovum was fertilised to become the embryo implanted in the womb of the gestational (surrogate) mother.•
A woman who legally takes on responsibility for the nurture of a child, through adoption, foster care, or a parental order, or alternatively, through marriage as a stepmother.The International Federation of Gynaecology and Obstetrics (FIGO) (2008) define surrogacy as:
. . . where a woman carries a pregnancy and delivers a child on behalf of a couple where the woman is unable to do so, because of congenital or acquired uterine abnormality or serious medical contraindication to pregnancy . . .
(FIGO 2008, p. 312) Brazier et al. (1998) define surrogacy as:
. . . the practice whereby one woman (the surrogate mother) becomes pregnant, carries and gives birth to a child for another person(s) (the commissioning couple) as the result of an
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agreement prior to conception that the child should be handed over to that person after birth . . .
(Brazier et al. 1998, Annexe A) The latter definition does not preclude commercial surrogacy arrangements for example.
Brazier et al. (1998) further defined a surrogate mother as:
. . . The woman who carries and gives birth to the child . . . or ‘surrogate’. She may be the genetic mother (‘partial’ surrogacy) – i.e. using her own egg – or she may have an embryo – which may be provided by the commissioning couple -implanted in her womb using in-vitro fertilisation (IVF) techniques . . .
(‘host’ or ‘full’ surrogacy [see Figure. 5.7]; Brazier et al. 1998, Annexe A) Adoptive mothers and foster mothers are more familiar variants of the social mothering role (see Figure 5.5) with whom midwives may also interact. The main difference is that a surrogacy arrangement is a contract, which is entered, prior to conception, for the benefit of the commis-sioning parents, whilst adoption and fostering are arrangements undertaken post-conception mainly for the benefit of the children (Wyatt 2009). Regardless of mode of conception, or iden-tity of the genetic parents, it is important that midwives grasp that UK law and the midwife’s sphere of practice recognises only the childbearing woman (gestational mother) as the mother during pregnancy and the postnatal period (ICM 2011 and NMC 2012. That is:
. . . the woman who is carrying or has carried a child as a result of the placing in her of an embryo or of sperm and eggs, and no other woman . . .
(Human Fertilisation and Embryology Act 2008) This is only superseded by the completion of a parental order, or through legal adoption (Griffith 2010). Parental orders take effect after six weeks postpartum; prior to this a surrogate mother may decide not to relinquish her baby (Human Fertilisation and Embryology Act 2008;
Griffith 2010).
Figure 5.10 Venn diagram illustrating the nature of biological and social fatherhood (Ber 2000;
Erin & Harris 1991; FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health 2008).
In some surrogacy arrangements the genetic father will also be the social father
Sperm donor Adoptive father/
stepfather
Genetic father (also the biological father)
Social (commissioning)
father Traditional
father
101 Midwives normally rely on childbearing women to identify their babies’ fathers. Sometimes, none is identified. In the traditional model of families, or the nuclear family, the husband is both the genetic father and the social father (see Figure 5.10), where a:
•
Genetic father is the man who provides the spermatozoon for fertilisation of the ovum.•
Social father is the man who provides nurture and care for the child following birth.The social father is a role shared by the traditional father, the commissioning father in a sur-rogacy arrangement, and also by stepfathers and adoptive fathers. The traditional father would have fulfilled both the social and biological roles.
Illustrated in Figures 5.11 and 5.12 are some potential combinations of non-traditional fami-lies in which a midwife could be involved, via surrogacy arrangements.
Figure 5.11 A surrogacy arrangement with heterosexual commissioning parents who are not genetically related to the baby.
Gen F:
Gen M:
Soc F:
Soc M:
Gest M:
B:
Genetic Father Genetic Mother Social Father Social Mother Gestational Mother Baby
Gen F:
Gen M:
Soc F:
Soc M:
Gest M:
B:
Genetic Father Genetic Mother Social Father Social Mother Gestational Mother Baby
Figure 5.12 A surrogacy arrangement with same-sex commissioning parents, neither of whom is genetically related to the baby.
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Midwives must act as advocates for gestational mothers and their babies, remembering to ‘ . . . listen to the people in . . . ’ their ‘ . . . care and respond to their concerns and preferences’
(NMC 2008, p. 3). However, they must negotiate and communicate sensitively with the family, as they choose to define themselves. Midwives are primarily concerned with supporting child-bearing women and babies whilst appreciating the diversity of parenting roles they may encounter.